Provider Demographics
NPI:1144709932
Name:CHANGESPACE CENTER FOR COUNSELING AND DEVELOPMENT LLC
Entity type:Organization
Organization Name:CHANGESPACE CENTER FOR COUNSELING AND DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAORENZA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-263-4361
Mailing Address - Street 1:4 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1924
Mailing Address - Country:US
Mailing Address - Phone:401-263-4361
Mailing Address - Fax:
Practice Address - Street 1:147 COUNTY RD STE 300A-B
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-4536
Practice Address - Country:US
Practice Address - Phone:401-263-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty